| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $3.14 | $79,999.20 | $79,999.20 |
Hydroxyprogesterone caproate
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $3.14 | $79,999.20 | $79,999.20 |